Provider Demographics
NPI:1700842838
Name:GRAY, KELLIE M (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:M
Last Name:GRAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:24022 N 79TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1626
Mailing Address - Country:US
Mailing Address - Phone:623-334-4056
Mailing Address - Fax:623-334-4060
Practice Address - Street 1:17215 N 72ND DR
Practice Address - Street 2:SUITE 105
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8558
Practice Address - Country:US
Practice Address - Phone:623-334-4056
Practice Address - Fax:623-334-4060
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4710111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist